MDNews - San Antonio

M D N E W S . C O M /// M D N E W S S A N A N T O N I O ■ 2 018 1 1 SPECIAL CLINICAL SECTION: CARDIOLOGY BY LAWRENCE E WIDMAN, MD, PHD THE HUMAN HE ART IS A WONDERFUL MACHINE, BUT SOME TIMES IT DE VELOPS PROBLEMS. THE MA JOR PLUMBING PROBLEMS ARE WELL KNOWN: HE ART AT TACKS, TIGHT VALVES, LE AK Y VALVES AND WE AKNESS OF THE MUSCLE IN ITS WALLS. BUT THE HE ART also has an electrical system, and its specialists are called cardiac electrophysiologists. In this article, I would like to discuss three of the common electrical problems that can develop in the heart and what can be done to help restore the patient to as vigorous and healthy a life as possible. The first problem is atrial fibrilla- tion. This rhythm arises in the upper chambers of the heart and often results in an irregular pulse that can be either too fast or too slow. Even when the pulse is normal, people with this rhythm just don't "feel right." The risk of getting it is increased by obstructive sleep apnea (OSA) and is reduced with e˜ective treat- ment of OSA. The most important risk of atrial fibrillation is stroke, and this risk can be halved by anticoagulation. There are also treatments that can cure atrial fibrillation in many patients. When it cannot be cured, the heart rate can almost always be controlled satisfactorily. The second problem is a slow heart beat, or chronotropic incompetence. In this rhythm, the natural pacemaker of the heart simply goes too slowly for the amount of exercise the person is trying to do. It begins very slowly, over a period of years, and often patients think they are just getting old. It is remarkable how many people say, after receiving a per ma nent pacema ker, t hat t hey feel 10 years younger! That's because their hearts are now able to beat as fast as they did 10 years before. The third problem is high risk for sud- den death due to one of the abnormally fast heart rhythms that can kill within minutes. Most commonly, this situation is due to damage to the muscle of the heart severe enough to cause shortness of breath and fatigue. There is a well-proven treatment, an implantable cardioverter- defibrillator (ICD), that can control the risk of sudden cardiac death with a pretty low risk of side e˜ects. For some reason, in the United States, many patients who could benefit from ICD treatment do not receive one. The magic number is a left ventricular ejection fraction (LVEF) of 35 percent or less. It is impor ta nt to remember that many people with the above conditions, and other problems with the electrical system of the heart, can lead active and fulfilling lives. In fact, after treatment, many of these people feel as good as they ever have. If you would like to discuss these or related issues, please feel free to call my o–ce at 210-615-9500. ■ ELECTROPHYSIOLOGY Topics in Clinical Cardiac to engage and empower individuals with chronic diseases to play an active role in managing their conditions, so that they may achieve better health and quality of life. This program takes advantage of the high-touch structure of the care Legacy currently provides to help patients cultivate the confidence and skills they need to e˜ectively take control of their health, set healthy living goals and successfully achieve them. Through a combination of EECP, chronic disease education and focused clinical research, Legacy Heart Care strengthens its dedication to elevating the individual patient experience while making a positive di˜erence in the health of our communities. To learn more about EECP, please contact our San Antonio o–ce at 210-558-1800 or visit our website at legacyheartcare.com.˜■ 1. Ward, B. W., Schiller, J. S., & Goodman, R . A. (2014). Peer reviewed: Multiple chronic conditions among us adults: A 2012 update. Preventing chronic disease, 11. 2. Centers for Disease Control and Prevention. (2015). CDC WONDER [database]. About Underlying Cause of Death, 1999–2013. 3. Zhang, C., Liu, X., Wang, X., Wang, Q ., Zhang, Y., & Ge, Z. (2015). E–cacy of enhanced external counterpulsation in patients with chronic refractory angina on Canadian Cardiovascular Society (CCS) angina class: an updated meta-analysis. Medicine, 94(47). 4. Qin, X., Deng, Y., Wu, D., Yu, L., & Huang, R . (2016). Does enhanced external counterpulsation (EECP) Significantly aŠect myocardial perfusion?: a systematic review & meta-analysis. PloS one, 11(4), e0151822. 5. Raza, A., Steinberg, K., Tartaglia, J., Frishman, W. H., & Gupta, T. (2017). Enhanced External Counterpulsation Therapy: Past, Present, and Future. Cardiology in review, 25(2), 59-67.

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